Role of Telemedicine in Pace of Consultation and Physicians’ Satisfaction in Thoracic Surgery ICU

Background: Despite various applications of tele-ICU, there are still many questions about its costs and advantages in ICU. Some of its advantages are accelerating consultations and bringing physicians’ satisfaction from tele-consultation outcomes. The aim of this study is to discuss these advantages. Materials and Methods: Initially a telemedicine network was implemented and in the case of having no related specialist, the physicians used telemedicine network to perform specialized tele-consultation to thoracic surgery ICU patients. ICU patient’s documents during a year before tele-consultation were studied and delay time in consultation was recorded and compared between the two phases. Finally, the physicians’ satisfaction with tele-consultation was evaluated. Results: Fifty-eight tele-consultations in various medical fields were carried out, of which 27 were neurology cases. From the time of receiving a consultation request to its performance, the mean time was 1.3 days in tele-consultation. Tele-consultations were given 2.5 times faster than face to face method. In evaluation of physicians’ satisfaction, 82.75% of them were fully satisfied from tele-consultation, 12.06% were partly satisfied and 5.17% were not satisfied. Conclusion: Since the length of hospitalization in ICU is crucial due to heavy costs of treatment, high risk of contamination and limited beds, performing timely consultation is a key factor in reducing hospitalization period. Tele-consultation in thoracic surgery ICU not only accelerates patient care, but also results in higher physician satisfaction.


INTRODUCTION
Tele-ICU is the use of advanced communication technologies by implementing a network in which a team of off-site physicians is connected with distant ICU patients to make clinical decisions.
Since the ICU patients are mostly complicated and cannot be mobilized, these patients usually suffer multiple organ disorders and it is essential to have the consultation of various specialists, usually off-site, to make proper decisions. Therefore, telemedicine can be considered an appropriate solution.
Some advantages of using telemedicine in consultation are decrease in the rate of transferring patients to other centers, accelerating patient management, decreasing side effects, and thus shortening the length of hospitalization (1,2). Moreover, using tele-ICU for the sickest patients is not only cost-effective (3); it can also promote the quality of services in ICU. Telemedicine in ICU has been studied in recent decades, but there are still many unanswered questions regarding the benefits of its application (4). Some advantages of telemedicine are accelerating consultations and bringing physicians' satisfaction from outcomes, especially in high risk thoracic surgery patients, which will be discussed in this study.

MATERIALS AND METHODS
This study was performed in a tertiary pulmonology/ thoracic surgery hospital as a cross sectional study. Patients selected for tele-consultation were mostly complicated thoracic surgery cases with multiple organ failure for whom transportation was not only infeasible, but also contraindicated. Also due to critical situation of patients, timely performance of consultation and reaching a conclusion was a necessity. The consulting physician was located in a remote hospital and long distance transportation was required to perform the visit. For teleconsultation, initially the necessary instructions were given to the project team, including physicians, nurses and IT personnel, on how to operate the system. The physician would provide all necessary documents (the patient's history, tests, ECG, radiology documents) and transfer to consultant physician via store and forward, and then discuss the case online via videoconference. It is noteworthy that only patients who had signed the consent letter for tele-consultation participated in the study.
To compare the pace of tele-consultation and regular (bedside) consultation the documents of ICU patients admitted during the year before starting tele-ICU were studied. In these cases the mean time between requesting consultation and visit by the off-site physicians was evaluated. Then this interval (mean time between requesting and answering the consultation) was compared between the two groups using Mann-Whitney nonparametric test.
Finally, the physicians' satisfaction from teleconsultation was assessed using a questionnaire comprising of three choices: fully satisfied, partly satisfied, and not satisfied. Full satisfaction was achieved when the consultations were given on-time, with desired results and effective in improving treatment. However, when there was a problem in consultation procedure but finally the requesting physician could get the desired result, he/she was partly satisfied. No satisfaction was declares when the requesting physician did not get any answer to the consultation.

Fifty
Satisfaction survey results showed that the physicians were fully satisfied with tele-consultations in 82.75% of cases. They were partly satisfied in 12.06% and not satisfied in 5.17% of consultations (Table 2).  (13). This emphasizes that the more these physicians become familiar with tele-ICU systems and the more they have satisfaction in using it, the wider the range of system utilization and eventually the more the ICU patients receive specialized management.
There are still many unanswered questions about the best way of implementing telemedicine in health care system of our country and therefore carrying out comprehensive studies is essential, but there is no doubt that if this happens, higher quality of patient care and satisfaction will result.

CONCLUSION
Physician's level of satisfaction and also the speed of responding to tele-consultations are the two important factors in rendering tele-consultations in ICU and it is anticipated that tele-consultation can be successfully implemented in our ICU's in the near future. It seems that implementing tele-ICU in hospitals might provide higher quality health services with proper pace and therefore progress of patient management in ICU is also anticipated.